Healthcare Provider Details

I. General information

NPI: 1013397157
Provider Name (Legal Business Name): GREGG BROWN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2015
Last Update Date: 08/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 SUNSET BLVD. MS#353
LOS ANGELES CA
90027-3606
US

IV. Provider business mailing address

4650 SUNSET BLVD. MS # 53
LOS ANGELES CA
90027-5182
US

V. Phone/Fax

Practice location:
  • Phone: 323-361-3849
  • Fax:
Mailing address:
  • Phone: 323-361-3849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: